Cuellar Sandra, Vozniak Michael, Rhodes Jill, Forcello Nicholas, Olszta Daniel
1 Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, USA.
2 Pharmacy Department, Hospital of the University of Pennsylvania, USA.
J Oncol Pharm Pract. 2018 Sep;24(6):433-452. doi: 10.1177/1078155217710553. Epub 2017 Jun 4.
The management of chronic myeloid leukemia with BCR-ABL1 tyrosine kinase inhibitors has evolved chronic myeloid leukemia into a chronic, manageable disease. A patient-centered approach is important for the appropriate management of chronic myeloid leukemia and optimization of long-term treatment outcomes. The pharmacist plays a key role in treatment selection, monitoring drug-drug interactions, identification and management of adverse events, and educating patients on adherence. The combination of tyrosine kinase inhibitors with unique safety profiles and individual patients with unique medical histories can make managing treatment difficult. This review will provide up-to-date information regarding tyrosine kinase inhibitor-based treatment of patients with chronic myeloid leukemia. Management strategies for adverse events and considerations for drug-drug interactions will not only vary among patients but also across tyrosine kinase inhibitors. Drug-drug interactions can be mild to severe. In instances where co-administration of concomitant medications cannot be avoided, it is critical to understand how drug levels are impacted and how subsequent dose modifications ensure therapeutic drug levels are maintained. An important component of patient-centered management of chronic myeloid leukemia also includes educating patients on the significance of early and regular monitoring of therapeutic milestones, emphasizing the importance of adhering to treatment in achieving these targets, and appropriately modifying treatment if these clinical goals are not being met. Overall, staying apprised of current research, utilizing the close pharmacist-patient relationship, and having regular interactions with patients, will help achieve successful long-term treatment of chronic myeloid leukemia in the age of BCR-ABL1 tyrosine kinase inhibitors.
使用BCR-ABL1酪氨酸激酶抑制剂治疗慢性髓性白血病已将慢性髓性白血病转变为一种可慢性管理的疾病。以患者为中心的方法对于慢性髓性白血病的恰当管理以及优化长期治疗结果至关重要。药剂师在治疗选择、监测药物相互作用、识别和管理不良事件以及对患者进行依从性教育方面发挥着关键作用。具有独特安全性特征的酪氨酸激酶抑制剂与具有独特病史的个体患者相结合，可能会使治疗管理变得困难。本综述将提供有关基于酪氨酸激酶抑制剂治疗慢性髓性白血病患者的最新信息。不良事件的管理策略以及药物相互作用的考量不仅在患者之间存在差异，而且在不同的酪氨酸激酶抑制剂之间也有所不同。药物相互作用可能从轻微到严重。在无法避免同时使用伴随药物的情况下，了解药物水平如何受到影响以及后续的剂量调整如何确保维持治疗药物水平至关重要。以患者为中心的慢性髓性白血病管理的一个重要组成部分还包括对患者进行关于早期和定期监测治疗里程碑意义的教育，强调坚持治疗对于实现这些目标的重要性，以及如果未达到这些临床目标则适当地调整治疗。总体而言，了解当前研究、利用药剂师与患者之间紧密的关系以及与患者进行定期互动，将有助于在BCR-ABL1酪氨酸激酶抑制剂时代实现慢性髓性白血病的成功长期治疗。
